References: Laxative
Am J Surg. 1976 Jan;131(1):47-53.
Effects of prophylactic antibiotics on colonic healing.
LeVeen HH, Wapnick S, Falk G, Olivas O, Bhat D, Gaurdre M, Patel M.
The effect of antibiotic colon preparation on the tensile strength and morphologic appearance of colonic anastomoses has been investigated in dogs. Preparation with preoperative kanamycin did offer a slight benefit over mechanical bowel cleansing. The addition of erythromycin and kanamycin to the preoperative bowel preparation significantly (p less than 0.001) improved the mean tensile strengh of the healing colonic anastomosis. Continuation of erythromycin and kanamycin for one week postoperatively almost doubled the mean tensile strength of the healing anastomosis. Continuation of erythromycin without kanamycin in the postoperative period provided little protection over the preoperative administration of kanamycin and erythromycin. Histologic examination showed that erythromycin and kanamycin given during the pre- and postoperative period changed the mode of healing from that of secondary intention to healing by first intention. The findings support the concept that soilage of the peritoneal cavity at the time of elective colon surgery is not as important as leakage caused by poor anastomotic healing. Antibiotic bowel preparation with kanamycin and erythromycin improves the healing of colonic anastomoses.
Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1247153&dopt=Abstract constipation laxative colon cleansing
Minerva Chir. 1999 Mar;54(3):127-37.
[The single-stage surgery of perforated colon carcinoma. Our experience of 46 cases]
[Article in Italian]
Gullino D, Giordano O, Masella M, Lijoi C, De Carlo A.
Divisione di Chirurgia Generale, Ospedale SS. Annunziata, USL 17, Regione Piemonte, Savigliano, Cuneo.
BACKGROUND: 46 cases of perforated colonic neoplasm (4.6% of the entire series): 11 (24%) of the right colon, 35 (76%) of the left colon; 19 males (41%) and 27 females (59%); mean age 67 years old, range 32-92 years. pTNM: stage II, 1 case (2%); stage III: 27 cases (59%); stage IV, 18 cases (39%). The aim of this study was to resolve the perforation and to treat the neoplasm in a single operation. METHODS: The various types of perforation included: 35/46 = 76% perforations in situ; 6/47 = 13% recent perforations upstream; and 5/46 = 11% at a distance from the neoplasia. The following types of peritonitis were observed: purulent localised 10/46 = 22%, purulent generalised 12/46 = 26%, fecaloid 18/46 = 39%, fecal 6/46 = 13%. In 24 cases/46 = 52% the perforation had occurred in an occluded colon. The preoperative finding of pneumoperitoneum in 12/46 = 26% indicated generalised fecaloid-fecal peritonitis. Surgery commenced by suturing the perforation followed wherever possible by standard colectomy: on the right in all 11 cases = 100%, on the left in 15/35 = 43%; only in the event of prohibitive local or in particular general conditions was Hartmann's segmentary colectomy used in 10 cases/35 = 29%, or a definitive preternatural anus in 10/35 = 29%. The following aspects are essential in this single-stage surgery: the emergency nature of the operation; massive dose antibiotic treatment limited to the pre- and perioperative stages and above all peritoneal cleansing using accurate, methodical, repeated and abundant lavage with 8-10-20 or more litres of polysaline isotonic solution at 37 degrees C, but only used 500 ml at a time. This lavage is essential to reduce bacterial load contributes to
JBR-BTR. 2002 Dec;85(6):289-96.
Optimisation of colon cleansing prior to computed tomographic colonography.
Gryspeerdt S, Lefere P, Dewyspelaere J, Baekelandt M, van Holsbeeck B.
Department of Radiology, Stedelijk Ziekenhuis, Roeselare, Belgium.
Colon preparation technique is a major determinant factor for patient compliance and polyp detection in computed tomographic colonography (CTC). The purpose of this study is to compare three different colon cleansing techniques in terms of patient discomfort, sensitivity and specificity. The following colon cleansing methods were compared in 20 patients each: 1. standard colonoscopy cleansing (ScCl) the day of the examination, based on polyethylene glycol (PEG), 2. a slightly reduced cleansing (RcCI) the day prior to the examination, based on a combination of diet, bisacodyl and a reduced intake of PEG, and 3. a cleansing with dietary fecal tagging (FT) the day prior to the examination, based on a combination of diet, bisacodyl, magnesium citrate and a dedicated barium suspension. ScCl resulted in a clean colon, but produces fluid levels hampering a complete CTC and possibly resulting in false negative diagnosis. RcCl reduced the problem of fluid levels, but was faced with the problem of fecal residues, resulting in false positive diagnosis. FT offered the possibility to obtain a dry colon, with labelled fecal residues, thus reducing false positive findings. Optimisation of the diet and replacement of PEG by magnesium citrate in FT reduced the preparation related discomfort and improved the final opinion. FT is the preferred colon cleansing technique because, compared to ScCl, fluid levels are reduced, and compared to RcCl, differentiation between faecal residues and polyps is improved. Moreover, FT reduces preparation related discomfort, compared to both RcCl and ScCl.
Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12553658&dopt=Abstract constipation laxative colon cleansing
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